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BWFE2016-024878-495 CALLE TAMPICO Ct 0 V �NNIICl/ LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BWFE2016-0248 Property Address: 49100 AVENIDA ANSELMO APN: - 658280005 Application Description: LANGE / 66LF OF 5/6' BLOCK WALL Property Zoning: Application Valuation: $4,000.00. Applicant: w JOSEPH BIRDSELL D P0BOX 630 DEC 15 2016 LA QUINTA, CA 92247 CITY OF LAQUINTAV COMMUNITY DEVELOPMENTDEPARTMENT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division the Business and Professions Code, and my License is in full force and effect. License Class: B License No.: 81 93 Dater Z^! :L 1/t Contra r:� OWNER-BUI E E RATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Contractors' State License law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. . B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Na Lender's Add VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/15/2016 Owner: ROBERT LANGE P 0 BOX 193 COCKEYSVILLE, MD 92253 Contractor: JOSEPH BIRDSELL P 0 BOX 630 LA QU I NTA, CA 92247 (760)409-7070 Lic. No.: 811293 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compiqsation, as provided for by Section 3700 of the Labor Code, for the performance of�e rk for which this permit is issued. 1( I have and will maintain workers' compensation insurance, as required by Secti9 700 of the Labor Code, for the performance of the work for which this permit is issue My workers' compensation insurance carrier and policy number are: Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9118059 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree t! at1l should become subject to the workers' compensation provisions of Secti n 370 of the Labor Code, I shall forthwith comply with those provisions. I Date: 6plicant:19l ✓ WARNING: FAILURE TO SECURE WORKERS' COENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application , the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, of cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinance; dity to tate laws relating to buil ing construction, and hereby authorize representatives f this enter upon the above-mentioned property for inspection purposes. I D 3� Signature (Applicant or A Date: 12/15/2016 Application Number: BWFE2016-0248 Owner: Property Address: 49100 AVENIDA ANSELMO ROBERT LANGE APN: 658280005 P 0 BOX 193 Application Description: LANGE / 66LF OF 5/6' BLOCK WALL COCKEYSVILLE, MD 92253 Property Zoning: Application Valuation: $4,000.00 Applicant: Contractor: JOSEPH BIRDSELL JOSEPH BIRDSELL P 0 BOX 630 P 0 BOX 630 LA QUINTA, CA 92247 LA QUINTA, CA 92247 (760)409-7070 Llc. No.: 811293 ---------------------------------------------------- r ----------------------------------------- Detail: 66LF,OF 5'/6' WING WALLS AND EQUIPMENT WALL. 2013 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT WALL/FENCE - FIRST 100 LF 101-0000-42404 0 $50.67 DESCRIPTION ACCOUNT QTY AMOUNT WALL/FENCE - FIRST 100 LF PC 101-0000-42600 0 $63.33 Total Paid for BLOCK WALL: $114.00 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 Bin ft Qty of La Quilita Building St Safety Division Permit #AVQQ . - 78-495 Calle Tampico ok2� La Quinta, CA 92253 - (760) 777-701,2 I3ulldmg Permit Application and Tracking Sheet Project`Address: 2 = t�0-twner's Name: JijScG /l/JQ A. P. Number: �A'ddress: Legal Description: � , ST, Zip: �` �Contracf r• i iz � G Z C.Q St ' Phone:�Kd .� /3o e G t7 t5�: 2 c)ProjectDescription: -�OLG1 �iC7itL, ST, Zipj 4N J v4-7 el Tel on P eP h i ktate_Lic. # : City Lic. #; Arch., Engr., Designer. Address: City, ST, Zip: Telephone: one: Con iru t' s cion Type: Occupancy: P P Y: State L ic. 1" Prect tYPa (circle ne • New ..........................:..::::::: J Add'n Alter Repair. Demo 1:Naamme of Contact Person: <z' Ll: Sq. Ft.: #Stories: # Units: t Telephone # Contact ' t -- of Person: �i �EStimated Value of Project: Q� APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item.' Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Dee Plans picked up S.M.I. O.A. Apal FINKOUSEE--:�- E Plans resubmitted Grading Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Dale of permit issue School Fees, I . Total Permit Fees t £9ZZ6 eiujo;iieo 'e)umb e -I ITS - - - - -- -, r- - -- - - - - - - - - - - - - a°t .....'. _ °a :p�A,`• o'�:'T .°.d�Oi ..°. �e°,t °�s�Ya `°>•�e}.e �»# "�u,� `i .�'�i� �# }; .K` Li�,,., .. _ _ _ __. -. .,. ___- _.. _ - _.. - - ;t �•r ,> •: Tns die•"t5.. a {.. °•t9 c�4 1 �� Ivl ,s`s� aid � 4'�' �'` .. -_ � .. . , . - - .. • .y a o : ,,���,°x'�b ,�� °�',lw. F-c•S•r,�:�. �'�':' aW�.. ,# � c�'"��XS� E � :"'�4 .x i#�$�Xl� y 3}�i.� ',� 1[li P"'. �-}''„ _ - _.- -:? 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